The punch-drunk boxer and the battered wife: Gender and brain injury research

Stephen T Casper,Kelly O'Donnell

doi:10.1016/j.socscimed.2019.112688

Stephen T Casper, Kelly O'Donnell

Open Access

https://doi.org/10.1016/j.socscimed.2019.112688

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Abstract

This essay uses gender as a category of historical and sociological analysis to situate two populations—boxers and victims of domestic violence—in context and explain the temporal and ontological discrepancies between them as potential brain injury patients. In boxing, the question of brain injury and its sequelae were analyzed from 1928 on, often on profoundly somatic grounds. With domestic violence, in contrast, the question of brain injury and its sequelae appear to have been first examined only after 1990. Symptoms prior to that period were often cast as functional in specific psychiatric and psychological nomenclatures. We examine this chronological and epistemological disconnection between forms of violence that appear otherwise highly similar even if existing in profoundly different spaces.

Highlights

In 1990 a letter appeared in The Lancet: “A 76-year-old woman was admitted to hospital unconscious after being found at home with multiple injuries
Relatives told us that her husband had been violent towards her for many years, in relation to his drinking, and the patient had often been seen with cuts and bruises.”[2]. The letter, titled “Dementia in a Punch-Drunk Wife,” was followed by a post-mortem description of a battered woman with a pathology found in deceased boxers with chronic traumatic encephalopathy
Both organs reached a very wide medical readership.[76]. It appears that no one connected the dots. It was not until 1990 that anyone thought to look for brain pathology in a battered woman

Summary

Introduction

In 1990 a letter appeared in The Lancet: “A 76-year-old woman was admitted to hospital unconscious after being found at home with multiple injuries. The Lancet connected two patient populations—boxers and victims of intimate partner violence—together for the first time.[3] Both conditions, referred to as punch-drunk disease and battered woman syndrome respectively, linked violence and medicine. As we argue in this paper, these developments demonstrate the peculiar way gender has historically produced differentiated outcomes in clinical practice.[19] While separated by an astonishing sixty years in their initiation, studies of brain injury in boxers and intimate partner violence reveal highly similar patient groups, albeit one situated in masculine displays and the other invisibly centered in domestic realms. The gendering of traumatic brain injury in these case studies is subtler than a public/private analysis alone can account for, as we elaborate below.[23] The disjuncture of these diagnoses is a microcosm of the social and cultural circumstances of their respective patient populations. The battered woman, in contrast, was ironically shunted back into a diagnostic domestic sphere, with social scientists reifying her location in the marital household, her auxiliary status within the family, and the primacy of her emotional state above all else

Methods

Brain injuries in context

Psychiatric wounds and the battered wife

Conclusion